Ch. 12 review

• Pregnancy


  Time of increased vulnerability, physical safety + social support
• SSRIs for pregnancy


  Secreted in breast milk
• Careful risk-benefit analysis for pregnant women
• Close monitoring for pregnant women taking SSRIs
• Avoid psychotropics during first trimester of pregnancy
• Psychotherapy


  First treatment option
• FDA pregnancy categories


  • Category 1 - no risk
  • Category B - no clear evidence of risk in humans
  • Category C - risk can't be ruled out
  • Category D - evidence of risk in humans
  • Category X - contraindicated in pregnancy
• Complementary and Alternative Medicine (CAM)

  • Increased mindfulness
  • Natural remedies
  • Shown to address symptoms of depression/anxiety
  • Lower risk combining with mainstream medical treatments
• St. John's Wort helpful with PTSD, not necessarily curative
• Consider entire presentation of patient, be aware of comorbidities & complexities that may affect response to treatment
• Adrenergic system


  Sympathetic nervous system = fight or flight
• PTSD


  Balance not maintained, system dysregulated, not return to normal level
• Adrenergic hyperactivity

  • Release of multiple neurotransmitters and neurohormones like epinephrine in individuals with PTSD
  • Appears to assist in encoding emotionally laden memories
• HPA axis (cortisol/stress response)

  Decreased levels in those living under chronically stressful conditions
• Trauma sensitizes HPA
• Neurobiological Window for optimal stress response

  Inhibit so SNS does not overshoot
• Neurogenesis

  Production of new cells within the nervous system
• PTSD symptoms

  Arise from excessive activation of SNS, probably in combo with dysregulation of HPA-axis
• Psychologically resilient individuals

  • Maintain SNS activation within a window of adaptive elevation, high enough to respond to danger but not so high as to produce incapacity, anxiety, or fear
• Treatment for PTSD

  1. Carefully titrated exposure to memory, so as not to overwhelm

  2. Increase emotional/stress regulation

  3. Use medication to stabilize limbic system

  4. Reduction of overall anxiety "load" through relaxation training, dampening SNS activation

  5. Use medication to reduce comorbidities
• Medications rarely sufficient to permanently resolve posttraumatic stress issues
• Psychotropic medications

  • Useful adjunct, some initial relief of intense distress, rarely curative by themselves
  • Initial symptom reduction can be gained through meds, more able and willing to engage
• PTSD highly comorbid